Allergic Reaction Associated with the use of Eugenol Containing Dental Cement in a Young Child

Case Report

Austin J Dent. 2014;1(2): 1007.

Allergic Reaction Associated with the use of Eugenol Containing Dental Cement in a Young Child

Deshpande A1, Verma S2 and Macwan C1*

1Department of Pedodontics and Preventive Dentistry, K. M. Shah Dental College and Hospital, India

2Dental Speciality Centre, India

*Corresponding author: Macwan Chirag, Department of Pedodontics and Preventive Dentistry, K. M. Shah Dental College and Hospital, Sumandeep Vidyapeeth, At & Po Pipariya, Waghodia, Vadodara, Gujarat- 391760, India

Received: July 02, 2014; Accepted: July 27, 2014; Published: July 30, 2014


Allergic contact stomatitis is a rare disorder which may be easily overlooked by the clinician. Eugenol is one such material known to cause such reactions. We present a case report of a 6-year old girl in whom adverse local reaction to eugenol, contained within temporary restorative material which illustrates this problem. Based on the history and clinical features, we arrived at a diagnosis of allergic contact stomatitis and successfully treated the lesions. Treatment generally consists of eliminating the causal agent. Careful assessment of patients and of their dental and medical history is necessary to avoid such adverse reaction in the office.

Keywords: Dental material; Allergic reaction; Eugenol; Contact stomatitis; ZOE cement


Allergic reactions associated to dental materials are not unknown [1]. Eugenol is widely used in dentistry in different forms and combinations. Eugenol has been widely used in dental products for many years. It has been incorporated into impression pastes, periodontal dressings, cements, filling materials, endodontic sealers, and dry socket dressings. Oil of cloves, or eugenol in its unrefined form, is mixed with zinc oxide to form zinc oxide-eugenol (ZOE), which exhibits a combination of physical and therapeutic properties making it useful as a provisional restorative material, base material, and root canal filling material [2]. The joint Food and Agriculture Organisation/WHO committee on food additives has permitted an acceptable daily intake of eugenol of 2.5 mg/kg body weight for humans [3]. It is considered non-carcinogenic and non-mutagenic and is generally recognised as safe by the Food and Drug Administration [4]. On the other hand, there are many studies about the cytotoxicity of eugenol [5,6]. The eugenol of ZOE cement can cause tissue effects, from low-grade local reactions to the rare, but serious, anaphylactic reaction. These reactions can be categorized into three types: direct tissue damage due to the nature of the medication; contact dermatitis/ stomatitis; and true allergic reaction [2,7]. However, there have been rare reports of hypersensitivity reaction to eugenol. In the present paper we have discussed a case of a young child in whom adverse allergic reaction was noticed due to ZOE cement, and this serves to remind colleagues of the need for care in its use.

Case Presentation

Six-year-old girl visited a private dental clinic with the chief complain of pain in maxillary left first and second primary molars (64, 65). No significant family and medical history was revealed. Intraoral examination revealed extensive disto-occlusion caries in 64 and 65. Radiographic examination revealed peri-radicular pathosis in 64 and 65, and these teeth were planned for multi-visit pulpectomy.

Under local anesthesia infiltration access opening and pulp extirpation were done. Root canal was irrigated with normal saline and closed dressing was given with form cresol cotton pellet. Access cavity was sealed with temporary restoration using Zinc Oxide Eugenol (ZOE) cement. Patient was recalled after two days for further treatment. Patient reported on the very next-day with complain of burning sensation and pain in the upper left back tooth region along with the history given by patient's guardian of itching in the same region after few hours of the treatment. Intraoral examination revealed allergic reaction "contact stomatitis" [8] caused by the ZOE cement on the gingiva and buccal mucosa (Figure 1). Intraoral periapical radiograph (IOPA) of 63, 64 and 65 region was taken that revealed that ZOE cement was in contact to soft tissue distal to the 65 (Figure 2). Patient's parent was explained about the unusual occurrence during the treatment and further management of the reaction. For confirmatory diagnosis of the lesion, "patch test" of zinc oxide powder and eugenol oil was planned for the patient. Parents were explained for the same, but they denied undergoing for patch testing for their child. Temporary restoration was removed, and normal saline irrigation was done to remove remnant of the ZOE cement. Glass Ionomer Cement (GIC) was used as a temporary restoration to avoid further insult to the tissue. The patient was kept under observation for a week. The lesion appeared to be healed after a week so pulpectomy was completed using Vitapex® (Calcium Hydroxide Paste with Iodoform) obturating material. Post obturatuion was done using GIC restorative material followed by stainless steel crown as a final restoration. No relapse or recurrence was observed during 3 months follow-up visit. Parents were also instructed for the future dental visits that they need to disclose that child is allergic to eugenol/ clove oil.

Citation: Deshpande A, Verma S and Macwan C. Allergic Reaction Associated with the use of Eugenol Containing Dental Cement in a Young Child. Austin J Dent. 2014;1(2): 1007. ISSN:2381-9189